Depression is the most prevalent mental health disorder and globally is two times more likely to occur in women. In rural areas of Bangladesh, women's autonomy in planning pregnancy and the likelihood of successful pregnancy remain uncertain, with stillbirth, perinatal and neonatal death occurring at over five-fold higher rates than in developed countries. These rates are likely to be higher for rural women with little access to medical care. Our aims are to study: 1) the relation of unintended pregnancy to maternal depressive symptoms in the third trimester of pregnancy and at six months postpartum; 2) the relation of unintended pregnancy and fetal and neonatal loss to postpartum maternal depressive symptoms; 3a) whether the relation of unintended pregnancy with postpartum maternal depressive symptoms differs by gender of the offspring; and 3b) whether the relation of fetal or neonatal loss with postpartum maternal depressive symptoms differs by gender of the offspring. Miscarriage, stillbirth, perinatal death, and neonatal death will be examined separately as risk factors. The proposed secondary analysis uses data from a population-based, randomized antenatal micronutrient supplementation trial conducted from 2001 to 2007 in northwestern rural Bangladesh among ~60,000 pregnant women. Women were enrolled in early gestation and followed through 6 months postpartum. Pregnancy outcomes and infant vital status were monitored weekly through 3 months of age. In the third trimester and at 6 months, symptoms of depression were elicited by maternal responses to questions about common depressive symptoms as well as about suicide. Statistical methods will include descriptive analyses and calculation of adjusted risk ratios to examine unintended pregnancy and fetal and neonatal death events as predictors of subsequent depressive symptoms. We will assess the effects of pregnancy intent from each parent as well as discordance between maternal and paternal pregnancy intentions on maternal depressive symptoms. Documentation of unintended pregnancy and loss of a fetus or infant as risk factors for depressive symptoms in a large South Asian population will help to show their extent and guide interventions relevant to a vulnerable period when maternal mental health is critical for the healthy development of her other children. PUBLIC HEALTH RELEVANCE: The proposed research takes advantage of a large population-based supplementation trial conducted among pregnant and postpartum women in rural Bangladesh. Our goal is to better understand unintended pregnancy, fetal and neonatal loss, and child gender as predictors of maternal depressive symptoms. Ultimately, identification of risk factors for prenatal and postpartum depressive symptoms will inform screening procedures, future epidemiological studies and intervention design and evaluation.